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Varying minimally invasive surgery rates indicate disparity in US surgical care
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The rates for several different types of minimally invasive surgeries vary significantly across the country and may indicate a lack of training as the cause, according to a recent study.
Michol A. Cooper, MD, and colleagues conducted a retrospective review of a nationwide inpatient sample database to determine hospital-level utilization of minimally invasive surgery for appendectomy, colectomy, total abdominal hysterectomy and lung lobectomy.
Based on patient characteristics, the researchers used a propensity score model to calculate the predicted proportion of minimally invasive operations for each hospital. The hospitals were then categorized as “low,” “medium” or “high” based on their actual to predicted proportion of minimally invasive surgery utilization.
Mean hospital utilization was 71% for appendectomy, 28.4% for colectomy, 13% for hysterectomy and 32% for lung lobectomy. Use of minimally invasive surgery varied significantly for each type of procedure; however, higher utilization of minimally invasive surgery was strongly associated with urban hospitals, large hospital size, teaching hospitals, and location in the Midwest, south and west regions.
Hospitals may be lacking in utilization of minimally invasive surgery because of the training of their fellows and residents, according to the researchers. This is because fellows and residents learn in an apprenticeship mode, but many of the surgeons they learn from may lack advanced minimally invasive surgery skills.
“Hospital utilization of minimally invasive surgery by procedure may be a meaningful process measure in health care to complement existing and maturing outcome measures of surgical care,” Cooper and colleagues wrote in the study. “Important ways to deal with this disparity may be more standardized postgraduate training, training of surgeons currently in practice, transparency of hospital rates of utilization of minimally invasive surgery and better information for patients.”
Disclosure: The authors have no relevant financial disclosures.
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Cooper M. BMJ. 2014. doi:10.1136/bmj.g4198.
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